| NPI | 1487645586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 2588AT) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: OR 2588AT) |
| 152WP0200X Optometrist Pediatrics (Licence: OR 2588AT) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2020-04-13 |